| Part Ⅰ.Prognostic factors of intrahepatic cholangiocarcinomaResearch background and purpose:Cholangiocarcinoma is the most common malignant tumor of the biliary system.According to the location of the bile duct,it can be divided into intrahepatic cholangiocarcinoma(ICC)and extrahepatic cholangiocarcinoma.Extrahepatic cholangiocarcinoma can be divided into hilar cholangiocarcinoma and distal cholangiocarcinoma.Intrahepatic cholangiocarcinoma refers to the bile duct with tumor located in the secondary branch and farther.It can be divided into mass type,nipple type,and invasive type according to gross pathology.Intrahepatic cholangiocarcinoma is the second most common primary liver cancer in the liver,which is second only to hepatocellular carcinoma(HCC),and its incidence accounts for about 10-25%of hepatobiliary malignancies.Thailand,South Korea and China in Asia are the high incidence areas of cholangiocarcinoma,113 of 100000 people in some regions develop cholangiocarcinoma.Although the incidence rate of cholangiocarcinoma in Europe and America is low,the incidence rate of cholangiocarcinoma has been increasing in recent decades.Compared with other liver tumors,ICC is more aggressive,usually with a poor prognosis,and is more prone to recurrence and metastasis.In this study,the possible factors affecting the prognosis of intrahepatic cholangiocarcinoma were statistically analyzed to find out the prognostic factors and to verify the risk factors of early recurrence of intrahepatic cholangiocarcinoma.Method:In this study,a retrospective study was used to screen 486 patients with intrahepatic cholangiocarcinoma as the research statistical objects,and the indexes that might affect the prognosis of the disease were analyzed by SPSS software and then drawn with R language.The comparison between the two groups used chi square test,corrected chi square or Fisher’s exact test.Kaplan Meier method was used to draw the overall survival curve and relapse free survival curve.Log rank method was used to compare the survival rates among groups,and to screen the influencing factors of the overall survival rate and the recurrence-free survival rate.Then,the clinical pathological factors were included in the Cox proportional risk model,and the w step back method(α in=0.10,α out=0.10)was used to determine the prognostic factors.P<0.05 was considered statistically significant.Result:486 patients with intrahepatic cholangiocarcinoma were included in the study.The median survival time was 45 months and the median progression free survival time was 28 months.The total 1、3、5-year survival rates were 79.27%、53.17%、44.07%respectively.The 1、3、5-year progression free survival rates were 72.21%、44.3%、37.28%respectively.Single factor analysis showed that the factors related to the overall survival of the patients were:albumin(HR=0.65,95%CI:0.49～0.86,P=0.003),prealbumin(HR=0,75,95%CI:0.56～0.99,P=0.043),Carbohydrate Antigen 19-9(HR=1.92,95%CI:1.44～2.55,P<0.001),CEA(HR=1.64,95%CI:1.24～2.18,P<0.001),glutamyltransferase(HR=1.37,95%CI:1.01～1.84,P=0.039),size-main tumor diameter(HR=2.13,95%CI:1.51～3,P<0.001),the closest distance between the cutting edge and the tumor(HR=0.7,95%CI:0.47～1.03,P=0.072),the number of tumors(HR=1.88,95%CI:1.40～2.51,P<0.001),lymph node metastasis(HR=2.03,95%CI:1.40～2.93,P<0.001),local invasion(HR=1.74,95%C I:1.13～2.67,P=0.012),lymph node metastasis Cleaning(HR=1.56,95%CI:1.04～2.34,P=0.032),abdominal adhesion(HR=1.57,95%CI:1.06～2.31,P=0.023),peritumoral focus(HR=1.9,95%CI:1.42～2.51,P<0.001),TNM stage(HR=1.48,95%CI:1.27～1.73,P<0.001).The.results showed that CA19-9(HR=1.68,95%CI:1.19～2.37,P=0.003),CEA(H R=1.7,95%CI:1.21～2.38,P=0.002),tumor diameter(HR=2.25,95%CI:1.43～3.56,P=0.001)and TNM stage(HR=1.35,95%CI:1.15～1.58,P<0.001)were independent risk factors for overall survival time.CA19-9(HR=1.64,95%CI:1.19～2.26,P=0.002),CEA(HR=1.64,95%CI:1.20～2.25,P=0.002),diameter of main tumor(HR=1.97,95%CI:1.32-2.92,P<0.001),lymphadenectomy(HR=1.61,95%CI:1.06～2.44,P=0.026),TNM stage(HR=1.25,95%CI:1.08～1.46,P=0.003)were independent risk factors for progression free survival.Conclusion:The single factors related to the overall survival of the patients included:albumin,prealbumin,CA19-9,CEA,glutamyltransferase,size-main tumor diameter,the closest distance between the cutting edge and the tumor,the number of tumors,lymph node metastasis,local invasion,lymph node dissection,degree of celiac adhesion,peritumoral focus,TNM stage.The single factors related to the postoperative progression free survival time of the patients included:albumin,prealbumin,CA19-9,CEA,glutamyltransferase,size-main tumor diameter,the closest distance between the cutting edge and the tumor,the number of tumors,lymph node metastasis,local invasion,lymph node dissection,degree of abdominal adhesion,peritumoral focus,TNM stage.In the multivariate analysis,CA19-9,CEA,tumor diameter and TNM stage were the risk factors for the overall survival time.CA19-9,CEA,diameter of main tumor,lymph node dissection and TNM stage were the risk factors of progression free survival.Part Ⅱ.Meta analysis of the effect of preoperative CA19-9 level on the prognosis of patients with intrahepatic cholangiocarcinomaObjective:To assess the effect of preoperative CA19-9 level on the prognosis of the patients with intrahepatic cholangiocarcinoma(ICC).Method:PubMed、EMbase、Web of science、CNKI、Wanfang、Weipu、China biomedical databases were thoroughly searched for the randomized Cohort studies on the influence of preoperative CA19-9 level on the prognosis of ICC patients.The retrieval time limit was from the establishment of the database to February 2020.The researchers independently selected the literature,collated data,and evaluated the bias risk included in the study.After that,the meta analysis was conducted by Revman 5.3 software.Result:A total of 12 cohort studies were included in this meta-analysis,which further have 2278 patients,including 1309 in the high CA19-9 group and 969 in the low CA19-9 group.The total survival rate of low CA19-9 index group was significantly higher than that of high CA199 index group with significant P value(RR=1.87,95%CI:1.52-2.29,I2=50.4%,P<0.001).In multivariate analysis,the progression-free survival rate of CA19-9 group with low index was significantly higher than that of CA199 group with high index(RR=1.68,95%CI:1.44-1.95,I2=67.2%,P<0.01).Conclusion:The overall survival rate of the low CA19-9 index group was significantly higher than that of the high CA19-9 index group,suggesting that CA19-9 has a significant predictive effect on the survival prediction model of ICC patients. |
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